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What is pelvic inflammatory disease?

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. The reproductive system includes the uterus, fallopian tubes, ovaries, and surrounding tissues. The infection starts at the cervix, which is the opening of the uterus into the vagina. The infection then moves up through the whole reproductive system. Sometimes it spreads to other places inside the abdomen.

PID is most common among younger women who have sex, especially with multiple partners. It rarely happens after menopause.

How does it occur?

Having sex with someone who is infected with gonorrhea or chlamydia is the most common cause. Normal bacteria found in the vagina and on the cervix can cause PID, but this is rare.

PID may also happen:

  • after a miscarriage, termination of pregnancy (also called a TOP or abortion), or childbirth
  • after rape
  • during use of an IUD for birth control, especially within the first 20 days after the IUD is placed inside the uterus
  • after pelvic surgery

What are the symptoms?

Sometimes there are no symptoms. When symptoms occur, they may include:

  • pain in the lower abdomen
  • abnormally heavy vaginal discharge
  • irregular or heavy menstrual periods
  • pain in the pelvic or abdominal area during sex
  • pain or burning when you urinate or have a bowel movement
  • flulike symptoms such as fever, general discomfort, tiredness, back pain, or vomiting

How is it diagnosed?

Your healthcare provider will ask about symptoms and give you a pelvic exam. Sometimes the pelvic exam is very uncomfortable due to pain in the uterus and tubes.

You may have the following tests:

  • tests of samples of blood, vaginal discharge, and urine
  • ultrasound scan
  • pregnancy test

You may have a test to see if you are pregnant because abdominal pain and vaginal bleeding can be symptoms of an ectopic (tubal) pregnancy. An ectopic pregnancy is a pregnancy that takes place outside the uterus.

You may need to have laparoscopy to confirm the diagnosis of PID. Laparoscopy is a surgical procedure done while you are under anesthesia. Your healthcare provider makes a small cut near your bellybutton and inserts a thin tube with a light and tiny camera through the cut. Your provider can then look at the organs in your abdomen and pelvis. If you have PID, your tubes and ovaries will be swollen and inflamed. Your provider may see pus, sores, or scar tissue on or around the female organs. Your provider may remove a sample of tissue (biopsy) for lab tests.

If your healthcare provider thinks you have PID, he or she may talk to you about testing for HIV (the virus that causes AIDS) and other sexually transmitted diseases (STDs).

What is the treatment?

PID is treated with antibiotic medicine.

  • Mild PID without fever or severe pain can be treated with antibiotic shots and pills.
  • A more serious infection needs several days of intravenous (IV) antibiotics given once or twice a day. This may be done at your healthcare provider’s office, the emergency room or clinic, or sometimes at home with visits from a nurse. After several days of IV antibiotics, you will need to take antibiotics by mouth.
  • If you have severe PID, you may need to stay in a hospital for continuous IV antibiotic treatment. Then you will take antibiotic pills for some time after you go home.

If you have pus in your pelvis (an abscess), you may need surgery to remove or drain it. If you have an IUD, your healthcare provider will probably remove it.

Your provider may prescribe pain medicine.

If your provider thinks your infection was caused by a sexually transmitted disease, others who have had sex with you must be examined and treated. This is necessary to keep you from getting infected again and to prevent spread of the infection to anyone else. Don’t have sex until both you and your partner have finished all of the medicine.

Your healthcare provider will probably want to see you again 2 to 3 days after you start your medicine. Your provider will check you to make sure the medicine has the infection under control. You also need to be checked 1 week after you finish all of the medicine to make sure that the infection is gone.

How long will the effects last?

You will start to feel better 2 to 3 days after starting the treatment. Make sure you finish all the medicine as prescribed.

If the infection is not treated, it could spread to other parts of your body or create an abscess in the fallopian tubes or ovaries. It might cause chronic (long lasting) pelvic pain.

PID can cause scarring of the fallopian tubes. This scarring could make it hard for you to get pregnant. Prompt and complete treatment is very important to try to keep your ability to have children. Scarring of the fallopian tubes also increases your risk of having a tubal pregnancy.

How can I take care of myself?

  • Take the full course of treatment that your provider recommends. Carefully follow the instructions for taking your medicine.
  • Do not have sex until your provider tells you it is OK.
  • Rest and take acetaminophen, ibuprofen, aspirin, or other medicines recommended or prescribed by your healthcare provider for pain relief and fever.
  • Put a heating pad on your abdomen to relieve cramping or pain. Use a low heat setting. Be careful not to burn yourself.
  • Call your healthcare provider right away if:
    • You have new symptoms.
    • Your pain gets worse.
    • You do not feel better in 3 days.
    • You vomit and cannot hold the medicine down.
    • You develop a fever over 101°F (38.3°C).
    • You feel you are getting sicker.
    • You feel pain on both sides of your pelvis.

How can I help prevent pelvic inflammatory disease?

The following practices may help prevent PID:

  • Have just 1 sexual partner who is not sexually active with anyone else.
  • Always use a latex or polyurethane condom to reduce the risk of infection every time you have sex.
  • Don’t have sex when you have an infection.
  • If you are sexually active, you and your partner should be tested once a year for Chlamydia and gonorrhea even if you don’t have symptoms. You can be infected and not know it. A urine test can be done to test for these diseases. Prompt treatment of these infections can keep them from turning into PID.

Developed by David W. Kaplan, MD, and Phyllis G. Cooper, RN, MN. Published by RelayHealth.
Last modified: 2011-06-30
Last reviewed: 2011-06-09 This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. References
Pediatric Advisor 2011.4 Index
© 2011 RelayHealth and/or its affiliates. All rights reserved.